By Judith Grace Amoit
In an innovative collaboration to improve neonatal care services, the Uganda Newborn Programme project team from Makerere University School of Public Health, led by Dr. Monica Okuga and Mr. Darius Kajjo, conducted a site visit to Luwero Hospital on Wednesday, April 3, 2024, to assess the progress their partner ADARA had made to institutionalize and functionalize the Neonatal Care Unit (NCU). The team also aimed to distil lessons that could be scaled up by learning about the unit’s achievements and challenges.
Initiated by the ELMA philanthropies, the Uganda Newborn Programme (UNP) is an investment involving a consortium of four partners (Makerere University School of Public Health, Baylor Uganda, Adara Uganda, and Nsambya Hospital) together with the Ministry of Health to consolidate and replicate the most effective newborn interventions in 20 districts within three regions of Uganda (Western, Kampala, and North-Central).
The programme targets to improve care for 120,000 small and sick newborns over three years and reduce newborn death by 40% in target hospitals.
Uganda Newborn Program from Makerere University during the site visit at Luwero National Regional Referral Hospital Luwero General Hospital, in collaboration with the Adara Group and Makerere University School of Public Health, has made remarkable strides in reducing neonatal mortality rates by establishing a Neonatal Care Unit (NCU).
The initiative, which commenced in 2022, was born out of the pressing need to address the challenges faced by women during referrals of their babies, particularly premature births. Before the establishment of the NCU, mothers had to endure long journeys to Kiwoko Hospital, located approximately 13 kilometers away from Luwero town, to access neonatal care services. Many families, unable to afford transportation costs, turned to traditional birth attendants (TBAs), leading to devastating outcomes for newborns.
Since its inception, the NCU has provided a lifeline for premature and sick babies, offering essential medical care and interventions to ensure their survival. Dr. Gloria Nakalema, Head of the NCU, recounted the unit’s journey from humble beginnings to its current state of progress. Initially operating with limited resources and space, the NCU has expanded its capacity with support from the Adara Group, evolving into a vital facility within the hospital.
One of the key achievements highlighted by Dr. Nakalema is the significant reduction in referrals to Kiwoko Hospital.. This has not only reduced mortality rates but has also strengthened the hospital’s ability to provide timely and comprehensive care to newborns in need.
According to the 2022 Uganda Demographic Health Survey, the neonatal mortality rate decreased from 27 (UDHS, 2016) to 22 deaths per 1,000 live births, which is close to the 2022/23 National Development Plan III target of 21 deaths per 1,000 live births.
Furthermore, Dr. Bruno Oyik, the Luwero General Hospital Medical Superintendent, commended the partnership with the Adara Group and Makerere University MNCH for their invaluable contribution to improving newborn care. He emphasized the importance of sustainable staffing levels and infrastructure enhancements to ensure the continued success of the NCU.
In a statement, Prof. Peter Waiswa,, one of the Key principal investigators of the Uganda Newborn Program from Makerere University School of Public Health, underscored the pivotal role of partnerships in improving healthcare outcomes for newborns, highlighting the collaboration with Kiwoko Hospital and funding from Elma Philanthropies as key drivers of progress. He emphasized the importance of leveraging lessons learned from Kiwoko Hospital’s decades of experience in newborn care to establish NCUs in general hospitals across the region.
“Initially, the work was done at Kiwoko, which has operated as a center of excellence in newborn care for over 20 years,” Prof. Waiswa explained. “We asked the question, Can the learning from Kiwoko be taken to general hospitals? So, we started by expanding first to Nakaseke, then Luwero Hospital, and other hospitals within the region. “The establishment of NCUs and the implementation of the Hospital to Home program have yielded significant success in improving neonatal care services. However, Prof. Waiswa highlighted key areas for improvement, including the need for critical infrastructure support from the government.
“We’ve provided equipment in the NCUs, and the units are being supervised, but critical services such as electricity, water, and communication need to be ensured by the government,” he emphasized. “We need enough medicines and equipment, and the government should have a budget to sustain these services because organizations like ADARA are only catalytic.”
Furthermore, Prof. Waiswa emphasized the importance of integrated family planning and support for mothers and families to ensure the well-being of newborns beyond the neonatal period.
“As we roll out new neonatal care units, we need to focus not only on the quality of care provided but also on the quality of care after discharge,” he concluded. “The Hospital to Home program plays a crucial role in supporting parents beyond the hospital, ensuring that newborns thrive in their homes and communities.”
Through these collaborative efforts and a commitment to excellence, Luwero General Hospital and its partners are pioneering innovative approaches to neonatal care, setting a precedent for improved healthcare outcomes for newborns in the region and beyond.
Lessons Learnt
Leadership engagement and Commitment by leaders- play a big role in functionalizing and sustaining initiatives. In Luwero, both the political wing ,e.g Chief Administrative Officer (CAO), councilors and the health team, were in agreement on the need of a NCU, therefore making it easy to functionalize
Starting small and then scaling up interventions is an ideal way of beginning an initiative.. This gives time to learn how to do things and to pick up best practices.
There is need to intervene across the whole health system. Whereas the challenge of space and equipment may be sorted, other challenges such as human resources and drugs need to be handled for the system to work effectively.